Pain managementPub Date : 2025-03-01DOI: 10.1080/17581869.2025.2470607
Sheethal N, Ashwin Pai V, Ramya Kateel, Arjun Balakrishnan, Raghavendra Nayak, Girish R Menon, Sunitha M, Ravitej Bhat
{"title":"Posterior scalp block with bupivacaine and dexmedetomidine for pain management in posterior fossa surgeries: a prospective, double blind randomized controlled trial.","authors":"Sheethal N, Ashwin Pai V, Ramya Kateel, Arjun Balakrishnan, Raghavendra Nayak, Girish R Menon, Sunitha M, Ravitej Bhat","doi":"10.1080/17581869.2025.2470607","DOIUrl":"10.1080/17581869.2025.2470607","url":null,"abstract":"<p><strong>Background: </strong>Pain management in posterior fossa surgeries poses significant challenges, with opioid-based approaches causing unwanted side effects. This study evaluates the efficacy of posterior scalp block using bupivacaine and dexmedetomidine compared to skin infiltration for managing perioperative pain.</p><p><strong>Methods: </strong>In this prospective, double-blind, randomized controlled trial, 34 adult patients undergoing elective posterior fossa surgeries were equally assigned to either posterior scalp block or skin infiltration groups. Outcomes measured included hemodynamic parameters, pain scores, opioid consumption, time to first analgesic, and sedation levels.</p><p><strong>Results: </strong>The posterior scalp block group showed significantly lower opioid consumption (211.47 ± 101.95 mcg vs 305.88 ± 117.10 mcg; <i>p</i> < 0.01) and pain scores (VAS 2.29 ± 0.9 vs 5.06 ± 1.3; <i>p</i> < 0.001) at 24 hours post-surgery. This group also demonstrated better hemodynamic stability and fewer rescue opioid requirements (9 vs 15 patients; <i>p</i> < 0.009).</p><p><strong>Conclusions: </strong>Posterior scalp block with bupivacaine and dexmedetomidine significantly improves pain management, reduces opioid use, and provides better hemodynamic stability compared to skin infiltration in posterior fossa surgeries.</p><p><strong>Clinical trial registration: </strong>CTRI/2023/07/0554959.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"131-140"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-03-01Epub Date: 2025-02-22DOI: 10.1080/17581869.2025.2463874
Joseph V Pergolizzi, Jo Ann LeQuang
{"title":"Low health literacy impact on headache diagnosis.","authors":"Joseph V Pergolizzi, Jo Ann LeQuang","doi":"10.1080/17581869.2025.2463874","DOIUrl":"10.1080/17581869.2025.2463874","url":null,"abstract":"<p><p>Health literacy has a broad range of impacts, including whether and where a person seeks treatment and how well that patient interprets and applies clinical recommendations. Patients with headache may not seek treatment, may fail to disclose even severe pain to their physician, and may not understand or adhere to treatment. Universal precautions can be a helpful initial approach, and information styles can be modified as needed over time. Patients should be asked about headache and explanations about headache causes and treatment should be given in everyday language. The teach-back method can confirm if patients understand instructions. Health literacy can impact how patients perceive their headaches and how well they adhere to treatments. Health literacy is a two-way street; it depends on the patient's ability to understand and act on clinical information and the clinician's ability to give clear information. Language and cultural barriers can adversely impact health literacy, even in patients who otherwise have good understanding of medical advice. While health literacy can impact outcomes, those with low or very high health literacy are most likely to be non-adherent, albeit for different reasons. Clinical action plans can be valuable for those with severe headache.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"141-147"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-03-01Epub Date: 2025-02-17DOI: 10.1080/17581869.2025.2467025
Victor Hugo Palhares Flávio-Reis, Yago Marcos Pessoa-Gonçalves, Camilo André Viana Diaz, Antonieta Santos Andrade Lamoglia, Chamberttan Souza Desidério, Carlo José Freire Oliveira
{"title":"Open label placebo for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials.","authors":"Victor Hugo Palhares Flávio-Reis, Yago Marcos Pessoa-Gonçalves, Camilo André Viana Diaz, Antonieta Santos Andrade Lamoglia, Chamberttan Souza Desidério, Carlo José Freire Oliveira","doi":"10.1080/17581869.2025.2467025","DOIUrl":"10.1080/17581869.2025.2467025","url":null,"abstract":"<p><strong>Aim: </strong>To assess the therapeutic potential of Open-Label Placebo (OLP) for chronic low back pain (CLBP).</p><p><strong>Materials & methods: </strong>A systematic literature search was conducted on 12 September 2024. Data extraction focused on follow-up and change-from-baseline data of the placebo or control groups. The effect sizes were calculated using the inverse variance statistical method.</p><p><strong>Results: </strong>A meta-analysis of four articles involving 171 OLP patients and 161 controls demonstrated a modest reduction in pain on the numerical rating scale (Mean difference = -0.62; 95% confidence interval: -1.09 to -0.14; <i>p</i> = 0.01; I<sup>2</sup> = 31%). However, according to GRADE, the certainty of evidence for this finding is very low due to methodological limitations of the included studies and potential biases. These findings, even if small, suggest potential benefits of OLP for pain reduction, with clinical relevance of the effect size being important depending on the clinical context and the patient's perspective.</p><p><strong>Conclusions: </strong>OLP demonstrated a reduction in pain, with a slightly greater improvement observed during shorter intervention periods. However, the certainty of this evidence remains very low, indicating that these findings should be interpreted cautiously. Future clinical trials are needed to further explore the potential and limitations of this intervention.</p><p><strong>Protocol registration: </strong>www.crd.york.ac.uk/prospero identifier is CRD42024568302.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"149-160"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-02-28DOI: 10.1080/17581869.2025.2473873
Syed I Khalid, Nikhil Veludandi, Chibueze Agwu, Konstantin V Slavin
{"title":"Altius electrical nerve stimulation for post-amputation pain treatment: a comprehensive review.","authors":"Syed I Khalid, Nikhil Veludandi, Chibueze Agwu, Konstantin V Slavin","doi":"10.1080/17581869.2025.2473873","DOIUrl":"https://doi.org/10.1080/17581869.2025.2473873","url":null,"abstract":"<p><p>Post-amputation pain (PAP), which includes both residual limb and phantom limb pain, affects up to 85% of amputees and severely impairs quality of life, mobility, and psychological well-being while incurring substantial healthcare costs. Conventional treatments - pharmacotherapy and neuromodulation techniques such as spinal cord stimulation and peripheral nerve stimulation - often provide inadequate relief and are associated with adverse effects like opioid dependence and systemic toxicity. The Altius High-Frequency Nerve Block System is an innovative therapeutic approach that delivers high-frequency alternating current (HFAC) directly to peripheral nerves, inducing a reversible conduction block without paresthesia. Clinical validation through the pivotal QUEST study - a multicenter, double-blind, randomized, active-sham controlled trial - has shown significant reductions in pain intensity and decreased reliance on pain medications in patients with chronic PAP. This review examines the physiological mechanisms of HFAC nerve block, outlines the development and clinical application of the Altius system, and evaluates its safety profile and broader implications for pain management. The findings suggest that the Altius system addresses a critical gap in PAP treatment, offering sustained pain relief, reduced opioid dependency, and improved quality of life for amputees.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"1-7"},"PeriodicalIF":1.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-02-01Epub Date: 2025-02-20DOI: 10.1080/17581869.2025.2467022
Enrique Lluch-Girbés, Lirios Dueñas, Filip Struyf, Eleonora Maria Camerone, Giacomo Rossettini
{"title":"Negative expectations and related nocebo effects in shoulder pain: a perspective for clinicians and researchers.","authors":"Enrique Lluch-Girbés, Lirios Dueñas, Filip Struyf, Eleonora Maria Camerone, Giacomo Rossettini","doi":"10.1080/17581869.2025.2467022","DOIUrl":"10.1080/17581869.2025.2467022","url":null,"abstract":"<p><p>The nocebo effect, a phenomenon wherein negative expectations can worsen symptoms, is increasingly acknowledged within the context of musculoskeletal conditions. While experimental evidence has, to some extent, examined negative expectations in shoulder pain, their specific relationship with nocebo effects and their manifestation in clinical practice remains unexplored. In this perspective, clinicians and researchers are guided by first examining the psychobiology and neurophysiology underlying nocebo effects from a basic science standpoint, thereby equipping clinicians with a robust understanding of the phenomenon. What are considered the primary potential sources of nocebo effects in individuals with shoulder pain are then outlined - namely, diagnostic labels, diagnostic imaging and special tests, the medicalization of normality, and overtreatment. Practical clinical strategies are subsequently proposed to mitigate nocebo effects arising from these sources. Finally, the research implications for advancing the study of nocebo effects in people with shoulder pain are discussed. Overall, this perspective provides a comprehensive overview of the impact of negative expectations and associated nocebo effects on shoulder pain outcomes. By identifying potential sources of nocebo effects that may emerge in everyday clinical practice, guidance on mitigating related negative expectations in patients with shoulder pain is offered.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"93-104"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-02-01Epub Date: 2025-01-21DOI: 10.1080/17581869.2025.2455372
Krishnan Chakravarthy, Maja Green
{"title":"Turning back the clock: reintroducing 'SAFE' principles to spinal cord stimulation for long-term therapy preservation.","authors":"Krishnan Chakravarthy, Maja Green","doi":"10.1080/17581869.2025.2455372","DOIUrl":"10.1080/17581869.2025.2455372","url":null,"abstract":"","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"55-57"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-02-01Epub Date: 2025-02-12DOI: 10.1080/17581869.2025.2463865
Matthew Carrillo, Jessica Yingst, Wen-Jan Tuan, David Giampetro, Jennifer E Nyland, Aleksandra E Zgierska
{"title":"Problems accessing pain care, and the adverse outcomes among adults with chronic pain: a cross-sectional survey study.","authors":"Matthew Carrillo, Jessica Yingst, Wen-Jan Tuan, David Giampetro, Jennifer E Nyland, Aleksandra E Zgierska","doi":"10.1080/17581869.2025.2463865","DOIUrl":"10.1080/17581869.2025.2463865","url":null,"abstract":"<p><strong>Aims: </strong>Prescribing restrictions have significantly impacted patients with chronic pain, leading to opioid medication tapering and reduced access. This study examines the consequences of these restrictions and their impact on patient health and pain management strategies.</p><p><strong>Patients & methods/materials & methods: </strong>This research explores barriers to pain care, especially opioid therapy, adverse health outcomes resulting from reduced access to pain medications, and alternative pain management strategies. The study analyzes data from a cross-sectional survey conducted by the American Chronic Pain Association (ACPA) between November 2014 and January 2015. The survey gathered quantitative data on demographics, healthcare access, pain management strategies, and challenges in obtaining prescribed medications, alongside qualitative responses. Descriptive statistics summarized quantitative findings; chi-square and t-tests compared those with and without medication access difficulties. Thematic analysis revealed recurring themes in qualitative responses.</p><p><strong>Results: </strong>The study reveals that over half of the respondents faced difficulties obtaining prescribed pain medications, leading to significant adverse health consequences, including unmanaged pain, psychological distress, and suicidal ideation.</p><p><strong>Conclusion: </strong>These findings highlight the urgent need to address systemic and personal barriers to pain medication access, and the need for patient-centered care that incorporates evidence-based, holistic pain management strategies and shared decision-making between clinicians and patients.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"81-91"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain managementPub Date : 2025-02-01Epub Date: 2025-02-03DOI: 10.1080/17581869.2025.2460961
Treah Haggerty, Courtney S Pilkerton, Patricia Dekeseredy, Abigail Cowher, Cara L Sedney
{"title":"The acceptability of combined management of comorbid obesity and back pain in a rural population: a mediation analysis.","authors":"Treah Haggerty, Courtney S Pilkerton, Patricia Dekeseredy, Abigail Cowher, Cara L Sedney","doi":"10.1080/17581869.2025.2460961","DOIUrl":"10.1080/17581869.2025.2460961","url":null,"abstract":"<p><strong>Aims: </strong>We do not know if patients find the coordinated treatment of comorbid obesity and low back pain acceptable in clinical practice. The primary purpose of this study is to evaluate patient-level interest in a combined back pain and obesity specialty treatment clinic.</p><p><strong>Methods: </strong>A survey was sent to patients over 18 with a diagnosis of back pain and a BMI over 30 through their electronic medical records. Statistical analysis was carried out to examine the role of weight and pain stigma in mediating beliefs about weight and back pain on interest in a combined clinic.</p><p><strong>Results: </strong>1290 people responded. Respondents reported moderate levels of experienced stigma relating to pain (9.4 ± 6.6) using the 32-point Stigma Scale for Chronic Illness and obesity (3.5 ± 1.1) using the 6-point Weight Bias Internalization Scale. Respondents expressed a moderate belief that back pain and weight were related (70.8% ± 21.7). Most patients (69.2%) were interested in a joint clinic.</p><p><strong>Conclusions: </strong>In a target population of patients with obesity and back pain, a combined clinic treatment plan is desirable. These results support the need to explore the feasibility and sustainability of innovative, combined, holistic care clinics to treat people with obesity and back pain.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"73-80"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Peripheral nerve field stimulation following dorsal root entry zone lesion: a technical note.","authors":"Rayan Fawaz, Audrey Thomas, Muriel Curtet, Anne-Marie Giner, Manon Duraffourg","doi":"10.1080/17581869.2025.2463875","DOIUrl":"10.1080/17581869.2025.2463875","url":null,"abstract":"<p><p>Peripheral nerve field stimulation (PNFS) can effectively manage pain localized to one or two dermatomes that are refractory to conventional approaches, such as chronic low back pain. However, its utility in pain management in the upper limbs is limited due to the risk of lead displacement related to articular and mobile segment constraints.In this technical note, we describe a 58-year-old man with neuropathic pain refractory to extensive medical treatment, and dorsal root entry zone lesion. Considering the patient's favorable response to transcutaneous electrical nerve stimulation, we used a two-step lead placement approach to improve the permanent placement of the electrode leads in the upper limb. After 1 year follow-up, the patient achieved at least 50% pain relief, with no signs of lead displacement or resistance during flexion and extension movements of the involved upper limb, illustrating the success of PNFS.</p>","PeriodicalId":20000,"journal":{"name":"Pain management","volume":" ","pages":"59-63"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}